Multiple Ground-glass Opacities Research Articles

Clinical Features and Surgical Treatment of Synchronous Multiple Primary Lung Adenocarcinomas With Different EGFR Mutations.

BackgroundWith the popularity of lung cancer screening and advances in imaging technology, more and more synchronous multiple primary lung adenocarcinomas (SMPLA) are being diagnosed clinically, however, the clinical characteristics and prognosis of SMPLA with different EGFR mutations remains unclear. We aimed to explore clinical features and surgical outcomes of these patients to aid in the diagnosis and treatment of SMPLA.MethodsMedical records of patients with different EGFR mutations who have been diagnosed as SMPLA and underwent surgical resection from March 2015 to December 2019 were retrospectively analyzed. Clinical characteristics, surgical outcomes, recurrence-free survival (RFS) and overall survival (OS) were investigated.ResultsA total of 70 patients (68.6% female and 77.1% non-somkers) were included. Total of 161 lesions in all patients, 84.4% were ground-glass opacity (GGO) lesions. EGFR mutations were detected in 108 lesions, most of which were L858R (35.4%) and 19Del (20.5%). The mutation rate of mixed GGO is significantly higher than that of pure GGO and solid nodules (SN); the mutation rate of invasive adenocarcinoma is significantly higher than that of other histology subtypes; the mutation rate of lesions >20 mm was significantly higher than that of ≤20 mm. However, there is no significant difference in the mutation rate of specific driver gene between different radiological features, pathological characteristics and sizes. After a median follow-up time of 29 months, the 3-year OS and RFS were 94.4% and 86.0%, respectively.ConclusionsA high discordance of EGFR mutations were identified between tumors in patients with SMPLA. Synchronous multiple lung adenocarcinomas with predominantly multiple GGO should be considered as SMPLA, and surgery may be aggressively performed for these patients due to a good prognosis.

Familial interstitial lung disease associated with surfactant protein C gene mutation in adults: report of two cases and literature review

Objective: To improve the understanding of clinical manifestations, imaging findings, diagnosis and treatment of surfactant protein C gene (SFTPC) mutation associated with familial interstitial lung disease in adults. Methods: Two cases of adult SFTPC gene mutation associated with familial interstitial lung disease diagnosed in the Affiliated Hospital of Medical School of Ningbo University were analyzed retrospectively, and the literature was reviewed. The literatures were retrieved with "family interstitial lung disease" "SFTPC gene" "surface protein C gene" "SFTPC gene mutation associated with familial international lung disease" and "surface protein C gene mutation associated with familial international lung disease" in PubMed, Embase, Ovid, Wanfang database and China National Knowledge Infrastructure (CNKI). Results: There were two patients with familial interstitial lung diseases(one male and one female) with an average age of 27.5 years. Ⅱ-2 patient had symptoms of dry cough and shortness of breath, and Ⅱ-1 patient had no symptoms. There were multiple cysts and fine reticular shadows in both cases. Ⅱ-2 patient had multiple ground glass opacities in both lower lungs. TheⅡ-2 patient was diagnosed with usual interstitial pneumonia (UIP) by transbronchial lung cryobiopsy. A total of 35 patients were included in this literature review, including 20 males, with an average age of 33.5 years. Of all the patients, the clinical symptoms were described in 30 patients. The main manifestations were shortness of breath (22/30), dry cough (18/30), clubbing finger (12/30), and 30% (9/30) of them were found by chest computerized tomography (CT) without symptoms. There were 17 cases with detailed description of chest CT imaging. The most common chest CT findings were multiple intralobular reticular opacities (17/17), multiple cysts (12/17) and ground glass opacities (7/17). The main histopathological pattern was UIP (24/26). Conclusions: The main clinical manifestations of SFTPC gene mutation associated with familial interstitial lung disease in adults are shortness of breath, dry cough and clubbing fingers. The main manifestations are multiple cysts and intralobular reticular opacities in combination with multiple ground glass opacities. There is no specific drug in the treatment at present and early treatment with hydroxychloroquine may have better curative effect. When the imaging findings show multiple cysts and intralobular reticular opacities in combination with multiple ground glass opacities, especially the age of onset is less than 50 years old, this disease should be considered.

Study on the correlations of different clinical types with imaging findings at initial diagnosis and clinical laboratory indexes in COVID-19 patients.

Objectives:To investigate the correlations of initial lab and imaging findings in COVID-19 patients of different clinical types.Methods:We retrospective analyzed patients confirmed with COVID-19 in the Fifth Medical Center of the People’s Liberation Army (PLA) General Hospital between February to April 2020, selected a total of 58 (N) patients with lab and imaging examinations that met the study criteria, using Artificial intelligence (AI) software to calculate the percentage of COVID-19 lesions in the volume of the whole lung, then the correlations of general information, initial chest CT examination after admission and laboratory examinations were analyzed.Results:The 58 (N) COVID-19 patients were divided into mild group [41(n) cases]: and severe group [17(n) cases]: according to patient’s condition. CT findings of the severe group and mild group mainly included single or multiple ground glass opacity (GGO), with lesions mainly distributed in the periphery of lungs or GGO mixed with consolidation, with lesions involved in peripheral and central areas of both lungs, accompanied other signs. A significant difference in CRP, IL-6, D-D, GGT was observed between the two groups (p < 0.05). The ratios regarding lymphocyte abnormality and neutrophil abnormality in the severe group were higher than those in the mild group (p < 0.05).Conclusion:The CT features at initial diagnosis of COVID-19 were mainly characterized by multiple GGO with or without partial consolidation in both lungs, with the lesions mainly distributed at the subpleural regions. Some lab test indexes were correlated with the clinical types of COVID-19.

How to optimize your set-up for a VATS right upper lobectomy

A 77-year-old woman with multiple ground-glass opacities, the largest of which measured 21 mm, has a biopsy-proven primary lung adenocarcinoma in her right upper lobe. We performed a 3-port right-sided VATS using the Copenhagen approach. There was no pleural effusion or evidence of pleural metastatic spread. A tumor was identified in the upper lobe. The surrounding lung tissue appeared normal. We performed a multilevel intercostal block using 0.25% levobupivacaine. The inferior pulmonary ligament was divided. The superior pulmonary vein and 2 branches of the pulmonary artery to the right upper lobe were dissected, encircled, and divided using tan reloads of the Endo GIA stapler. The right upper lobe bronchus was dissected, encircled, and divided in a similar fashion using a purple reload of the Endo GIA stapler following a successful test inflation of the lower and middle lobes. The horizontal fissure was completed with further firings of the stapler. Lymph nodes from stations 2, 4, 7, 8, 9, 10, and 11 were sampled and sent separately for histological analysis. There was no parenchymal or stump leak to 20 cm H20 on the test inflation. Hemostasis and pneumostasis were checked and ensured. A single 24 Fr drain was placed in the apex. Hemostasis was complete. The incision was closed in layers.

TB MASQUERADING AS LUNG MALIGNANCY

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Radiological manifestations of pulmonary tuberculosis (TB) tend to be heterogeneous. [1] In this report, we highlight one such atypical manifestation that posed a diagnostic dilemma and necessitated a biopsy. CASE PRESENTATION: A 67 year old male with no known medical illness presented with a 3 month history of dry cough to a hospital in southern India. The cough was associated with night sweats, appetite loss, fatigue and intermittent fever. He reported no episodes of breathlessness or hemoptysis. He denied any sick contacts, was a non smoker and had no family history of malignancy. On examination, his vital signs were stable and he was not in respiratory distress. There were no palpable lymph nodes Cardiopulmonary examination revealed no abnormal findings. Blood examination showed hemoglobin of 11.9 g/dL and ESR of 54 mm/hr, with normal blood cell counts. Chest radiograph revealed opacities in the right middle zone. A high resolution computed tomography (HRCT) of the thorax was done, and findings raised suspicion of neoplastic changes.HRCT revealed a patchy consolidation with necrotic areas and irregular margins in the superior segment of the right lower lobe, extending up to the costal pleura. Multiple ground glass opacities with nodular thickening of the oblique fissure were noted in the right lower lobe as well. Due to their typical appearance, these features were attributed to a neoplastic etiology. Interestingly, a homogenously enhancing lobulated mass was noted in the prevascular compartment of the superior mediastinum. It was also seen abutting the SVC posteriorly, where it caused a focal compression on the left brachiocephalic vein. This was thought to be a lymph nodal mass. Computed Tomography (CT) guided biopsy of the right lower lobe lesion was conducted. Histopathology revealed granulomatous inflammation with epitheloid and giant cells surrounding areas of caseous necrosis. The patient was started on Anti Tuberculous Treatment and responded well. Follow up imaging six months later revealed fibrotic changes with calcified granulomas. DISCUSSION: Clinical and radiological manifestations of TB are heterogeneous and include a variety of benign and malignant diseases. [1] Diagnostic dilemmas can delay appropriate treatment, favoring Mycobacterium tuberculosis transmission. Up to one third of TB cases have an atypical appearance on radiograph or CT imaging. [2] Thus, despite demographic features and symptoms typical of TB, our patient's HRCT posed a diagnostic dilemma. The consolidation with necrotic areas and superior mediastinal mass raised suspicion for lung malignancy. CONCLUSIONS: An extensive workup is required to differentiate TB from lung malignancy. HRCT and biopsy can be critical. Comprehensive awareness and knowledge of atypical TB manifestations can help in early diagnosis and start of therapy, increasing the probability of clinical and microbiological cure. REFERENCE #1: Collu C, Fois A, Crivelli P, Tidore G, Fozza C, Sotgiu G, Pirina P. A case-report of a pulmonary tuberculosis with lymphadenopathy mimicking a lymphoma. Int J Infect Dis. 2018 May;70:38-41. doi: 10.1016/j.ijid.2018.02.011. Epub 2018 Mar 1. PMID: 29477363. REFERENCE #2: Jeon KN, Bae K, Park MJ. Atypical radiologic appearances of pulmonarytuberculosis in non-HIV adult patients. In Proceedings: The RoyalAustralian and New Zealand College of Radiologists (RANZCR) 63rdAnnual Scientific Meeting, and Asian Oceanian Congress of Radiology(AOCR), 30 August–2 September 2012, Sydney, Australia;http://dx.doi.org/10.1594/ranzcraocr2012/R-0200 DISCLOSURES: No relevant relationships by Arup Ganguly, source=Web Response No relevant relationships by Vinayak Jain, source=Web Response No relevant relationships by Adithya Shetty, source=Web Response

LEAKY LUNGS: A COMPLICATION OF COVID-19 PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: COVID-19 pneumonia can result in complications such as ARDS, septic shock, thromboembolic events, and kidney failure. Spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema are rare complications. CASE PRESENTATION: A 72-year-old African American female presented with a four day history of dyspnea. She was tachypneic with respiratory rate of 25/min with O2 saturation of 67% on room air, oxygen therapy via nonrebreather mask improved the O2 saturation to 92%. PCR test for SARS-CoV-2 was positive. Laboratory studies revealed a D-dimer-1121 ng/ml, C-reactive protein-15.97mg/dl, ferritin-356.8 and lactate dehydrogenase-337 U/L. Chest X-ray showed focal areas of interstitial and alveolar opacities. A CT scan of chest showed multiple focal ground glass opacities in the bilateral lung fields. She was treated with dexamethasone, remdesivir and supplemental oxygen. Two days later she became more hypoxic and chest X-ray showed increased interstitial opacities and a small pneumomediastinum. She was placed on high flow nasal cannula oxygen therapy. On the fourth day, her condition acutely worsened and she was emergently intubated without any complications and placed on mechanical ventilation with tidal volume of 6ml/kg ideal body weight. Post intubation chest-X-ray showed extensive pneumomediastinum, subcutaneous emphysema and right sided pneumothorax. Bilateral chest tubes were placed. Ultimately the patient passed away. DISCUSSION: COVID-19 pneumonia presents with a wide spectrum of symptoms, ranging from febrile illness to complications like ARDS, respiratory failure, and septic shock. Spontaneous pneumothorax, subcutaneous emphysema and pneumomediastinum are relatively rare complications. We presented a case of COVID-19 pneumonia who developed these complications while getting appropriate treatment. COVID-19 pneumonia can cause diffuse alveolar damage, desquamation of pneumocytes and cellular fibromyositis [1,2]. Increase in alveolar pressure by coughing or Valsalva maneuver can cause marginal alveoli to rupture and leak air into the interstitial space. The air then dissects between the perivascular and the peri-bronchial sheath into the mediastinum, pleural space and subcutaneous tissue causing pneumomediastinum, pneumothorax and subcutaneous emphysema respectively. Higher level of LDH is associated with increased risk of air leak from the lungs [3]. Small pneumothoraces can resolve on their own, but larger require chest tubes. Pneumomediastinum and subcutaneous emphysema are usually self-limiting benign conditions which resolve with bed rest, analgesics, and oxygen therapy [3]. CONCLUSIONS: Sudden deterioration in the oxygenation in COVID-19 patient should prompt clinicians to think of possible air leakage. Management of pneumomediastinum, subcutaneous emphysema and smaller spontaneous pneumothorax is conservative but large and tension pneumothoraces require chest tube. REFERENCE #1: Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case Report: Pneumothorax and Pneumomediastinum as Uncommon Complications of COVID-19 Pneumonia-Literature Review. Am J Trop Med Hyg. 2020;103(3):1170-1176. doi:10.4269/ajtmh.20-0815 REFERENCE #2: Shan S, Guangming L, Wei L, Xuedong Y. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19: case report and literature review. Rev Inst Med Trop Sao Paulo. 2020;62:e76. Published 2020 Oct 9. doi:10.1590/S1678-9946202062076 REFERENCE #3: Elhakim TS, Abdul HS, Pelaez Romero C, Rodriguez-Fuentes Y. Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: a rare case and literature review. BMJ Case Rep. 2020;13(12):e239489. Published 2020 Dec 12. doi:10.1136/bcr-2020-239489 DISCLOSURES: No relevant relationships by Prakash Adhikari, source=Web Response No relevant relationships by Nikhil Madala, source=Web Response

Chest CT-Scan Findings of an Iraqi Patient with Symptomatic Covid-19 Disease

Background: On the first of June, 2021, 1,201,352 cases of covid-19 were reported by the Iraqi Ministry of Health, and 16375 patients died because of the disease. The aim of this paper is to describe chest CT-scan findings of an Iraqi patient who was observed early during June, 2021, and had symptomatic covid-19, but he didn’t need hospitalization. Patients and methods: A forty-year old school teacher developed covid-19 disease with fever, fatigue, anorexia, and cough. The patient recovered after about two weeks. Results: Chest CT-scan performed during first week of illness showed: (1) Multiple bilateral ground glass opacities. (2) Atelectatic bands. (3) Thickening of the interlobular septa. (4) Vascular thickening. Conclusion: The chest CT-scan findings in this Iraqi patient was rather typical of covid-19 disease and included the most commonly reported abnormality of ground-glass shadows.

Evolution of Cavitary Lesion in a Case of COVID-19 Pneumonia: A Rare Entity

Abstract Introduction Toward the end of 2019, a novel coronavirus was identified as the causative organism of a cluster of pneumonia cases in Wuhan, China, spreading rapidly resulting in an epidemic throughout China, followed by a global pandemic. The initial radiological findings of coronavirus disease 2019 (COVID-19) pneumonia at the early stage on a computed tomography (CT) scan include multiple small patchy shadows and interstitial inflammation, predominantly distributed in the peripheral one-third of the lungs. Gradually, it develops into multiple ground glass opacities and infiltrates in the lungs. Furthermore, pulmonary consolidation is observed, but pleural effusion is rare. Objective From time of presentation to complete recovery, CT scans show significant morphological changes in the lesions, but very few literatures have reported cavitary lesion in the lungs. We present the case of a 64-year-old patient with COVID-19 pneumonia who had typical manifestations of the disease on a CT scan along with constantly changing small cavity in the lung. Discussion Delayed cavitation is a rarely described radiological manifestation of COVID-19. Atypical presentations of COVID-19 raise possibility of other infections or additional diagnoses. Bacterial and fungal infection should be excluded, as well as cavity-causing organisms. Although the proper mechanism of cavitation in COVID-19 pneumonia is not known, it may be due to intra- alveolar hemorrhage, diffuse alveolar damage, and necrosis of parenchymal cells based on findings of autopsy reports. Early and late complications associated with COVID-19 are yet to be defined. Conclusion Common causes of cavitary lesions must be investigated properly in all patients. Most cases are self-limited hence managed conservatively. The clinical spectrum of disease due to COVID-19 continues to evolve. Physicians must be aware of evolving radiological findings of COVID-19 and must conduct regular follow-up of convalescent patients with COVID-19 to ensure complete recovery.

GROUND GLASS OPACITY- (GGO) MIMICS AND ITS CHAMELEONS IN THE ED A LITERATURE REVIEW

Background : The COVID-19 pandemic has created an unprecedented health care crisis with, disruptions in both routine and emergency health care delivery and immense strain on health care resources . The clinical spectrum of disease with coronavirus disease (COVID-19) infection is variable and ranges from an asymptomatic infection or mild upper respiratory tract illness to severe viral pneumonia with respiratory failure and occasionally death. In a resourceconstrained environment with a high community burden of the disease and rapid point-of-care testing either unavailable or showing negative results, CT has been used to rapidly triage patients into non COVID-19, possible COVID-19, or most likely COVID-19 . As per the Fleischner Society consensus statement, CT is appropriate in certain scenarios, including for patients who are at risk for and/or develop clinical worsening .The common chest CT findings of COVID-19 are multiple ground glass opacity(most common), consolidation and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. The ground-glass opacities are usually peripherally located with the lower lobes being commonly involved. Imaging differentiation is important for management and isolation purposes and for appropriate disposition of patients . (1,7) The purpose of this article is to discuss the common presentations of emergency department with ground glass opacities and to review the differential diagnosis of typical imaging findings of COVID-19. Ground glass opacities appear in a variety of disease processes of emergenc Conclusion : y department presentations . Not all presentations with GGO” s have SARS COV2 or Covid -19 viral pneumonia .

Chest CT-scan findings of an Iraqi patient with symptomatic covid-19 disease

Background: On the first of June, 2021, the total number of the registered cases of covid-19 by the Iraqi Ministry of Health was 1,201,352 , and the total number of deaths was 16375 patients. The aim of this paper is to describe chest CT-scan findings of an Iraqi patient who was observed early during June, 2021, and had symptomatic covid-19, but he didn’t need hospitalization. Patients and methods: A forty-year old school teacher developed covid-19 disease with fever, fatigue, anorexia, and cough. The patient recovered after about two weeks. Results: Chest CT-scan performed during first week of illness showed: (1) Multiple bilateral ground glass opacities. (2) Atelectatic bands. (3) Thickening of the interlobular septa. (4) Vascular thickening. Conclusion: The chest CT-scan findings in this Iraqi patient was rather typical of covid-19 disease and included the most commonly reported abnormality of ground-glass shadows

Different Clinicopathologic and Computed Tomography Imaging Characteristics of Primary and Acquired EGFR T790M Mutations in Patients with Non-Small-Cell Lung Cancer.

PurposeAlthough patients with primary and acquired epidermal growth factor receptor (EGFR) T790M positive non-small-cell lung cancer (NSCLC) respond to osimertinib treatment, the optimal treatment strategy differs for these two groups of patients. This study aimed to compare the clinicopathologic and computed tomography (CT) imaging characteristics between primary and acquired EGFR T790M mutations in patients with NSCLC before treatment.Patients and MethodsWe enrolled two groups of patients with primary or acquired EGFR T790M mutation NSCLC (n = 103 per group) from January 2012 to December 2019. We analyzed their clinicopathologic and CT characteristics and differences between the groups. The groups were further categorized based on 21L858R and 19del to exclude the effect of coexistent mutations.ResultsPrimary, compared to acquired, T790M mutation tends to coexist with 21L858R (P < 0.001), exhibiting earlier tumor stage (P < 0.001), higher differentiation (P = 0.029), higher proportion of lepidic subtype adenocarcinoma (P < 0.001), and significant associations with some CT features (multiple primary lung cancers, ground-glass opacity, air bronchogram, and vacuole sign [all P < 0.001]). The combined model, composed of clinicopathologic and conventional CT signature and CT-radiomic signature, showed good discriminative ability with the area under the receiver operating characteristic curve 0.90 and 0.91 in the training and validation datasets, respectively. The T790M mutation contributed to these differences independently of coexistent mutations.ConclusionWe identified clinicopathologic and CT imaging differences between primary and acquired T790M mutations. These findings provide insights into developing future personalized T790M mutation status-based theranostic strategies.

Clinical study of invasive pulmonary aspergillosis following influenza A H1N1.

This study to analyze the clinical characteristics of patients with invasive pulmonary aspergillosis (IPA) following influenza A (H1N1) infection.We retrospectively analyzed 10 cases with IPA following H1N1 infection. The clinical manifestations, laboratory examination results, chest computed tomography, and treatments were analyzed.Clinical manifestations: all 10 cases had typical flu-like symptoms at the onset of the disease, among which 7 patients developed dyspnea in the late stage, and 8 patients had hemoptysis. Laboratory examination: the absolute and percentage of peripheral blood lymphocytes in all 10 patients were declined, among which 5 cases were with decreased CD3+ CD4+ T cells/lymphocytes; 9 cases with increased bronchoalveolar lavage fluid galactomannan; 6 cases with increased serum galactomannan; 1 case with bronchoalveolar lavage fluid cultured aspergillus fumigatus; and 2 cases with aspergillus by second-generation sequencing. Chest computed tomography: all patients showed multiple diffused ground-glass opacities at the beginning, along with linear or reticular interstitial changes. Two cases had multiple subarachnoid nodules with halo signs, 3 cases had consolidation in multiple segments of both lungs, 2 cases had cavities, and 4 cases were with pleural effusion. Treatment: 10 patients were treated with antiviral and anti-Aspergillus drugs after admission. Four patients received respiratory support. All 10 cases were cured and discharged.Early diagnosis of IPA in influenza A (H1N1) patients is the key to successful treatment.

Disease state prediction for 2019 novel coronavirus (COVID-19) pneumonia using CT manifestations and body temperature dynamic analysis: A SQUIRE-compliant study.

2019 Novel Coronavirus (COVID-19) is a new acute infectious disease of respiratory system, posed a great threat to human health because of its strong infectivity and rapid progress. This study aimed to assess the severity of COVID-19 Pneumonia by analyzing the change of CT manifestations and body temperature.This retrospective review included 22 patients with COVID-19 pneumonia. The imaging manifestations and clinical features were observed and evaluated.Most of the infected patients were men (13/22, 59%). Fever (>38°C) (17/22, 77%) and cough (6/22, 27%) were the main symptoms. Leukocytes count decreased in 23% of patients and lymphocyte decreased in 41%. Twenty-one patients with pneumonia had abnormal findings on chest CT. The special CT manifestations were observed at the first CT examination when the lesions progressed, including a single ground glass nodule with uneven density, multiple ground glass opacities distributed in subpleural, and the ground glass opacities confined in superior lobe. The special CT manifestations were observed at the first CT examination when the lesions resolved, including ground glass opacities with homogeneous density. The lesion involved in the bilateral lungs and the absorption of the lesions mainly occurred in bilateral inferior lobes. Three patients had normalized body temperature increased more than 1°C within 1 to 2 days after admission. Ten patients fluctuated more than 1°C within 1 to 7 days after admission and the second CT scans showed the disease was at the progressive stage.Dynamic analysis of CT manifestations and body temperature have the potential to predict the severity of COVID-19 pneumonia.

Pulmonary Findings of [18F]FDG PET/CT Images on Asymptomatic COVID-19 Patients.

During the coronavirus disease 2019 (COVID-19) pandemic, several case studies demonstrated that many asymptomatic patients with COVID-19 underwent fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) examination for various indications. However, there is a lack of literature to characterize the pattern of [18F]FDG PET/CT imaging on asymptomatic COVID-19 patients. Therefore, a systematic review to analyze the pulmonary findings of [18F]FDG PET/CT on asymptomatic COVID-19 patients was conducted. This systematic review was performed under the guidelines of PRISMA. PubMed, Medline, and Web of Science were used to search for articles for this review. Articles with the key words: “asymptomatic”, “COVID-19”, “[18F]FDG PET/CT”, and “nuclear medicine” were searched for from 1 January 2020 to 20 May 2021. Thirty asymptomatic patients with COVID-19 were included in the eighteen articles. These patients had a mean age of 62.25 ± 14.85 years (male: 67.71 ± 12.00; female: 56.79 ± 15.81). [18F]FDG-avid lung lesions were found in 93.33% (28/30) of total patients. The major lesion was [18F]FDG-avid multiple ground-glass opacities (GGOs) in the peripheral or subpleural region in bilateral lungs, followed by the consolidation. The intensity of [18F]FDG uptake in multiple GGOs was 5.605 ± 2.914 (range from 2 to 12) for maximal standardized uptake value (SUVmax). [18F]FDG-avid thoracic lymph nodes (LN) were observed in 40% (12/40) of the patients. They mostly appeared in both mediastinal and hilar regions with an SUVmax of 5.8 ± 2.93 (range from 2.5 to 9.6). The [18F]FDG uptake was observed in multiple GGOs, as well as in the mediastinal and hilar LNs. These are common patterns in PET/CT of asymptomatic patients with COVID-19.

Co-infection with nocardia and mycobacterium tuberculosis in a patient with systemic lupus erythematosus: A case report

Objective: Pulmonary infection is an important cause of morbidity and death in immunosuppressed patients. Recent studies showed that infections caused by Nocardia are quite rare, especially mixed infections with Nocardia and Mycobacterium Tuberculosis (MTB). This case emphasizes the importance of being alert to the possibility of co-infection in immunosuppressed patients. Case description: A 31-year-old female patient presented to the outpatient clinic with recurrent fever and cough. She had also suffered from Systemic Lupus Erythematosus (SLE) and type V lupus nephritis for 8 years. Additionally, she tested positive for the Nocardia nova complex and MTB following culture of the sputum/bronchoalveolar lavage fluid (BALF) and lung tissue. Initial Computed Tomography (CT) showed a bi-pulmonary massive high-density shadow with multiple cavities, Ground-Glass Opacity (GGO) and multiple miliary nodules. After admission, the patient was given Cefoperazone-Sulbactam (CSL) for empiric treatment and also received low-flow oxygen therapy. Four days later, microscopic examination suggested infection with Nocardia and CSL was replaced with Trimethoprim/Sulfamethoxazole (SXT), Moxifloxacin (MFX) and Imipenem (IPM). On the 9th day, the Nocardia nova complex was confirmed although there was a significant improvement in pulmonary symptoms and imaging results. However the images showed that there was no significant change in GGO and miliary nodules. Moreover, 18 days later she was confirmed with MTB infection and was subsequently transferred to the infectious diseases hospital for further treatment. Conclusion: Immunosuppressed patients have higher morbidity and mortality after opportunistic infection with pulmonary pathogens such as Nocardia and MTB. Therefore, early detection of pathogens and selection of appropriate antimicrobial therapy can significantly improve the prognosis.

Abnormal Coagulation Function of Patients With COVID-19 Is Significantly Related to Hypocalcemia and Severe Inflammation.

This study aimed to detect, analyze, and correlate the clinical characteristics, blood coagulation functions, blood calcium levels, and inflammatory factors in patients with mild and severe COVID-19 infections. The enrolled COVID-19 infected patients were from Wuhan Jin Yin-tan Hospital (17 cases, Wuhan, China), Suzhou Infectious Disease Hospital (87 cases, Suzhou, China), and Xuzhou Infectious Disease Hospital (14 cases, Xuzhou, China). After admission, basic information was collected; X-ray and chest CT images were obtained; and data from routine blood tests, liver and kidney function, myocardial enzymes, electrolytes, blood coagulation function, (erythrocyte sedimentation rate) ESR, C-reactive protein (CRP), IL-6, procalcitonin (PCT), calcitonin, and other laboratory tests were obtained. The patients were grouped according to the clinical classification method based on the pneumonia diagnosis and treatment plan for new coronavirus infection (trial version 7) in China. The measurements from mild (56 cases) and severe cases (51 cases) were compared and analyzed. Most COVID-19 patients presented with fever. Chest X-ray and CT images showed multiple patchy and ground glass opacities in the lungs of COVID 19 infected patients, especially in patients with severe cases. Compared with patients with mild infection, patients with severe infection were older (p = 0.023) and had a significant increase in AST and BUN. The levels of CK, LDH, CK-MB, proBNP, and Myo in patients with severe COVID-19 infection were also increased significantly compared to those in patients with mild cases. Patients with severe COVID-19 infections presented coagulation dysfunction and increased D-dimer and fibrin degradation product (FDP) levels. Severe COVID-19 patients had low serum calcium ion (Ca2+) concentrations and high calcitonin and PCT levels and exhibited serious systemic inflammation. Ca2+ in COVID-19 patients was significantly negatively correlated with PCT, calcitonin, D-dimer, PFDP, ESR, CRP and IL-6. D-dimer in COVID-19 patients was a significantly positively correlated with CRP and IL-6. In conclusion, patients with severe COVID-19 infection presented significant metabolic dysfunction and abnormal blood coagulation, a sharp increase in inflammatory factors and calcitonin and procalcitonin levels, and a significant decrease in Ca2+. Decreased Ca2+ and coagulation dysfunction in COVID-19 patients were significantly correlated with each other and with inflammatory factors.

At the Crossroad of Decision: “One-stop Shop” to Treat Multiple Ground-glass Opacities

At the Crossroad of Decision: “One-stop Shop” to Treat Multiple Ground-glass Opacities

Electromagnetic Navigation Bronchoscopy-Guided Microwave Ablation Combined With Uniportal Video-Assisted Thoracoscopic Surgery for Multiple Ground Glass Opacities

BackgroundAn increasing number of patients are being diagnosed with multiple ground glass opacities (GGOs), but a consensus on the treatment of these patients is still lacking. The aim of this study was to investigate the safety and feasibility of a novel technique, electromagnetic navigation bronchoscopy (ENB)-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery in patients with multiple GGOs. MethodsThe clinical, radiographic, surgical, and pathologic data of patients with multiple GGOs who underwent ENB-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery from October 2018 to December 2019 were reviewed. ResultsEleven patients with multiple GGOs underwent ENB-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery; they included 6 men and 5 women with a mean age of 61.3 ± 5.1 years (range, 53 to 68). Thirty-seven lesions were observed in the 11 patients, 21 of which were microwave ablated and 16 of which were surgically resected. Only 1 patient had postoperative pneumothorax and subcutaneous emphysema and was successfully discharged from the hospital after symptomatic treatment. The success rate and the efficiency of microwave ablation under ENB guidance were both 100%, with no other serious complications or procedure-related deaths occurring. No local metastasis or recurrence occurred in any patients during the follow-up period. ConclusionsElectromagnetic navigation bronchoscopy-guided microwave ablation combined with uniportal video-assisted thoracoscopic surgery is safe and feasible in patients with multiple GGOs suspected of having multiple primary lung cancers, and may represent an alternative approach for more patients, particularly patients who cannot tolerate the simultaneous resection of multiple tumors.

A longitudinal follow-up of COVID-19 patients in the convalescent phase showed recovery in radiological results, the dynamics of lymphocytes, and a decrease in the level of IgG antibody: a single-centre, observational study.

BackgroundGiven the high prevalence of coronavirus disease 2019 (COVID-19) globally, and the increased number of patients being discharged, it is necessary to understand the health consequences of COVID-19 to formulate and manage public policy concerning convalescent patients.MethodsA longitudinal follow-up investigation of 25 patients from a tertiary hospital in Henan provincial was conducted 8 weeks after discharge. Of these patients, 15 attended a second follow-up appointment 8 weeks after that. A throat swab reverse transcription-polymerase chain reaction (RT-PCR) analysis for SARS-CoV-2 and chest computerized tomography (CT) scans were implemented at the first follow-up appointment, and a total of 40 blood samples (25 from the first and 15 from the second follow-up appointment) were collected. Patients’ levels of Immunoglobulin G (IgG) antibody against S-Receptor binding domain (S-RBD) and Nucleocapsid Protein (NP) of SARS-CoV-2 and the subpopulation of lymphocytes were evaluated using an enzyme-linked immunoassay (ELISA) test and flow cytometry, respectively.ResultsAt the first follow-up appointment, 10 of the 25 patients (40.0%) showed complete radiological resolution. Of these patients, 80.0% were classified as moderate, and 80.0% were younger (those whose age was ≤ the median age of all the patients). The predominant patterns of abnormalities included an irregular line (12/25, 48.0%), ground-glass opacity (GGO) (44.0%), and multiple GGOs (28.0%). At the first follow-up appointment, 40.0% (10/25) of patients still had lymphopenia. Of the 15 patients who were followed-up with twice, the ratio of lymphopenia was 80% (12/15), 60.0% (9/15), and 46.7% (7/15) at 0, 8, and 16 weeks after discharge, respectively. This was mainly due to a decrease in the cluster of differentiation (CD) 4+ T lymphocyte, which was observed in 60% (9/15), 60% (9/15), and 46.7% (7/15) of total patients at 0, 8, and 16 weeks after discharge, respectively. All of the patients were S-RBD and NP IgG antibody positive at the first follow-up appointment. 40.0% (6/15) and 66.7% (10/15) of patients showed a decrease over 50.0% in the level of NP and S-RBD IgG antibodies, respectively, at the second follow-up appointment. The NP and S-RBD IgG antibodies’ levels declined to 44.6% (P=0.044) and 28.1% (P=0.18), respectively. 0 and 26.7% (4/15) of patients turned from NP and S-RBD IgG antibody positive to negative, respectively.ConclusionsAbout half of the patients still showed at least 1 abnormality in chest CT scans 8 weeks after discharge and lymphopenia 16 weeks after discharge. The level of the IgG antibody had declined by the follow-up appointment. Notably, the S-RBD IgG antibody declined more dramatically than that of NP. These results may have implications in the making of policies related to disease prevention, the long-term management of discharged patients, and vaccines’ development.

Comparison of Perioperative Outcomes Between Precise and Routine Segmentectomy for Patients With Early-Stage Lung Cancer Presenting as Ground-Glass Opacities: A Propensity Score-Matched Study

IntroductionSegmentectomy is widely used for early-stage lung cancer presenting as single or multiple ground-glass opacities (GGOs). Precise segmentectomy is the recommended procedure in China. However, clinically, most routine segmentectomies are performed using only high-resolution computed tomography (CT). The aim of this study was to evaluate the effect of two segmentectomy approaches for GGOs in the lung.MethodsFrom January 2020 to September 2020, 55 precise segmentectomies performed with real-time guidance using 3D reconstruction and 343 routine segmentectomies for patients with single or multiple GGOs were performed as uniportal procedures. To reduce bias related to outcomes, preoperative clinical factors were used for propensity score matching (1:1); 55 precision and 55 routine segmentectomies were selected and further analyzed. Perioperative outcomes, namely operation time, blood loss, resection margins, number of removed lymph nodes, postoperative pulmonary function (1 month after surgery), length of postoperative stay, and postoperative complications were compared between the two groups.ResultsPatients constituted 43 men and 67 women, with an age range of 25–68 years (median: 53 years). No significant differences were seen between the groups regarding blood loss, complications, histological type, and postoperative pulmonary function, and there were no 30-day postoperative deaths in either group. The median operation time for the Precision group (74 min) was longer than in the Routine group (55 min) (p <0.01), and the number of removed lymph nodes in the Precision group (5 ± 1.1) was higher than in the Routine group (3 ± 0.8) (p <0.01). Chest tube duration days and postoperative stay days were similar in both groups; however, the rate of air leakage on postoperative day 1 was higher in the Precision group (p = 0.020). All patients in the Precision group had adequate resection margins. Four patients (7.3%) undergoing complex segmentectomy in the Routine group had inadequate resection margins and required resection of additional lung tissue.ConclusionRoutine segmentectomy can significantly shorten the operation time and might prevent postoperative air leakage in uniportal segmentectomy for lung GGOs. However, precision segmentectomy may be more precise for complex cases, ensuring adequate resection margins and lymph node dissection.